Cognitive Behavioural Therapy (CBT)

Written by Dr Alice Boyes [Clinical Psychologist Christchurch New Zealand].

1. What is Cognitive-Behavioural Therapy (CBT) / Cognitive Therapy?

CBT is a time-limited, focused, problem-solving orientated therapy. CBT is collaborative in that the client and psychologist will work together to help the client to solve their problems and change problematic thoughts and behaviours. CBT is generally concerned with the present rather than on the past. Clients who participate in CBT learn important psychological skills which help prevent their problems from recurring in the future.

There have been hundreds of scientific studies of CBT, and it’s is widely regarded as the most effective psychological treatment for depression, anxiety, and eating disorders. There has been more research on CBT than any other psychological treatment.

2. What happens in a typical session of Cognitive Behavioural Therapy?

CBT sessions are quite structured so clients know what to expect when they come to treatment. Once the session starts, the psychologist and client do a brief check-in about what has happened for the client in the time since the psychologist and client last saw each other. During the check-in the client and psychologist review what the client found most and least helpful about the previous session and ascertain if there are any issues from the previous session that need to be followed up on. Since CBT involves clients doing self-help tasks between appointments, the psychologist and the client also talk about the self-help task the client has done at home.

Next, the psychologist and client set an agenda for the main part of the session. Clients can put items on the agenda to be dealt with during the session. Usually each session is focused on dealing with one main issue so that enough time can be devoted to that issue. The main part of the session is spent working on solving the client’s problems. This can involve working on thoughts, emotions, behavior, or physical issues.

Towards the end of the session, the psychologist and client make a plan together for the client to do a self-help task at home. These self-help tasks are aimed at the client putting into practice what they’ve worked on during the session.

One of the hallmarks of CBT is that it’s expected that a lot of the work and progress that occurs happens outside of appointments. Research has shown that people who do self help “homework” assignments in between appointments tend to have better outcomes from their treatment.

The psychologist and client decide together what would be the most helpful self help task for the client to do, and how to make it manageable.

Lastly, the psychologist and client review the session. This is an opportunity for the client to ask any remaining questions they have, bring up anything that’s bothered them about the session, or clarify anything they think the psychologist has misunderstood. Clients are encouraged to ask questions and clarify issues during the session, as well as during the end of session review.

3. What is an assessment?

The first time I see a client is for an initial 2 hour appointment for assessment (after this sessions are for 1 hour).

The purpose of assessments is for the psychologist to get a comprehensive picture of:

(a) the difficulties the client is having, (b) who the client is as a person, and (c) what the client most wants help with.

Assessments are extremely important because the psychologist and client decide together on a treatment plan based on the information that’s gathered in the assessment phase.

4. How long does treatment take?

The decision about how many treatment sessions clients will have is usually made jointly by the psychologist and the client.

For less severe problems, clients may need as little as 6-8 sessions.

Standard Cognitive Behavioral Therapy (CBT) is usually 10-20 sessions for moderate to severe problems.

If a client can only afford a certain number of sessions, treatment can be planned around this constraint but I need clients to tell me this before we start working together so I can think about the best approach for their particular circumstances and difficulties.

Sessions usually start out being weekly and then become less frequent when clients have experienced significant improvements in their difficulties.

It’s recommended that clients have booster sessions 3, 6, and 12 months after they finish treatment.

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